Plastic and Reconstructive Surgeons Bring Innovative Lymphedema Procedures to Brigham and Women’s Faulkner Hospital

Breast cancer-related lymphedema is a painful condition that affects roughly 30 percent of women who have axillary lymph node dissection with radiation to treat their cancer. The first signs might be something as simple as your jewelry feeling tight, but the condition can progress causing severe swelling and infection risk in the impacted arm.

Traditional treatment options for lymphedema include regular visits to an occupational therapist, wearing compression garments and using compression pumps at home. For patients with lymphedema, their lives often become consumed with managing their condition. But now, as part of the comprehensive Brigham and Women’s/Dana-Farber Cancer Institute team devoted to the treatment of breast cancer, Shailesh Agarwal, MD, and Michael Broyles, MD, both offer surgical treatment options for breast cancer-related lymphedema here at BWFH.

While surgery is not a cure for lymphedema, the two procedures offered can help prevent lymphedema and help make existing lymphedema more manageable. “These operations dramatically improve quality of life,” says Dr. Broyles.

Preventing Lymphedema

Across Brigham and Women’s/Dana-Farber Cancer Institute’s breast cancer care team, leading experts collaborate to design a treatment plan tailored to each individual patient. That treatment may include breast cancer surgery, breast reconstruction, radiation oncology, medical oncology and rehabilitation services like occupational therapy.

For patients whose cancer treatment plan includes axillary lymph node dissection and radiation oncology, Dr. Agarwal or Dr. Broyles can be called in to perform LYMPHA (Lymphatic Microsurgical Preventive Healing Approach) at the same time as the axillary lymph node dissection to help prevent lymphedema from ever developing.

If breast cancer has spread to the lymph nodes, axillary lymph node dissection is required to remove the impacted lymph nodes. The LYMPHA procedure involves creating a shunt between the impacted lymphatic channel and the blood vessel. This is called a lymphatic-venous bypass and helps blocked lymphatic vessels drain into the blood circulation.

“We have really good data that tells us if a patient is having axillary lymph node dissection and having radiation, the chance of developing lymphedema is over 30 percent. But if we’re able to intervene at the time of axillary lymph node dissection, those chances fall into the single digits,” says Dr. Broyles.

Help with Existing Lymphedema

Patients who have received breast cancer treatment outside of Brigham and Women’s/Dana-Farber Cancer Institute and developed lymphedema or patients who did not have LYMPHA at the time of their axillary lymph node dissection within Brigham and Women’s/Dana-Farber Cancer Institute and developed lymphedema also have a surgical treatment option.

Dr. Agarwal or Dr. Broyles can transplant lymph nodes from other areas of the body to the armpit where they were taken beforehand, creating new pathways for lymph fluid to drain from the affected limb. With this procedure, many patients see dramatically improved quality of life. As another benefit, this procedure can be performed at the time of the breast reconstruction procedure without any additional scars.

“For the longest time, when someone developed breast cancer-related lymphedema, they would be referred to an occupational therapist who would give them compression wraps or compression massages or send them home with a pump. While those options help prevent the lymphedema from getting worse they rarely help reverse it,” explains Dr. Broyles.

With lymph node transplant, improvement is possible. “Lymph node transfer can reduce the amount of compression and the extent of compression needed, as well as the time and pain associated with the treatment,” says Dr. Agarwal. “It’s not going to cure it, but it will make substantial improvement. It can also improve scaring in the axilla, which leads to comfort in an area that might otherwise feel tight.”

Surgical treatment of lymphedema is just part of the process. “We communicate closely with the occupational therapists who do a lot of conservative lymphedema management as well so that we can provide patients with comprehensive and seamless care,” says Dr. Agarwal. “Whether you are a candidate for surgery or will do well with occupational therapy alone, we want to see you so that we can go over all of your options.”